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| Year : 1981 | Volume
: 27
| Issue : 3 | Page : 187-188b |
Tube-bouginage technic in the management of urethral stone (case reports).
Dasgupta HK, Gupta VV
How to cite this article:
Dasgupta H K, Gupta V V. Tube-bouginage technic in the management of urethral stone (case reports). J Postgrad Med 1981;27:187-188b |
The small stones are known to migrate from the upper urinary tract into the bladder and then are ejected out per urethra with urinary stream. But at times, during passage through the urethra the calculus gets impacted even when there is no distal organic obstruction. The management of such recently impacted calculus varies according to the site and nature of the calculus. The methods to deal with the situation are to bring out the stone by forward milking or external urethrotomy if situated in the anterior urethra. The former procedure is quite traumatizing to the urethral wall and a failed attempt followed by external urethrotomy is invariably followed by permanent urethral fistula in the case of penile urethral stone. External urethrotomy even as a primary procedure is best avoided in penile urethra for the same reason.[1] In the case of posterior urethral stone, the steel bougie is used to dislodge the calculus back into the bladder. If this is accomplished either the calculus is removed by means of an aspirating bulb and cannula or if it is too large to pass through the cannula, it is crushed by cystoscopic lithotrite.
The attempt at redislodgement of stone into the bladder with steel bougie may not be always effective because the cranial end of the bougie fails to provide even support to the calculus and deflects side ways. This difficulty was overcome by using the following device.
Instruments
A set of metallic bougie and Magill's plain endotracheal tubes (or plastic tubes of different diameters fashioned to resemble Magill's endotracheal tube) are kept on instrument table. The proper sized, plain, endotracheal tube which can be negotiated per urethra is selected. This is now mounted snugly over a metallic bougie. The oblique tracheal end of Magill's tube is kept projecting for a centimeter beyond the cranial end of the bougie [Fig. 1].
Technique
The procedure is carried out under anaesthesia (in case of anterior urethral stone) so as to relax the external urethral sphincter. The urethra is well filled with xylocaine jelly and massaged gently towards perineum. The endotracheal tube mounted on bougie is passed on to redislodge the urethral stone by retrograde bouginage method (in anterior or posterior urethra). The projecting oblique end of the plain endotracheal tube provides good support and exerts even pressure on the stone surface, thereby redislodging the stone into the bladder [Fig. 2]. on page 188 A.
Case 1:
H., an adult of 20 years was admitted with impacted calculus at the penoscrotal junction of twenty-four hours' duration with dribbling of urine [Fig. 3] on page 188 A and was managed with the foregoing technique [Figs. 1] and [Fig :5] The immediate postdislodgement urethrogram was normal.
Case 2:
B., a child age 5 years was admitted with calculus impacted in mid-penile urethra of six hours' duration and was managed with herein described technique [Figs. 6], [Fig. 1] and [Fig. 2] on page 188B.
| 1. | Strafflon, R. A. and Higgins, C. C.: Urolithiasis: Urethral calculi. In, "Urology". Ed.: Campbell, M. F. and Harrison, J. H., 3rd Edition, Vol. 1, W. B. Saunders Company, Philadelphia, London and Toronto, 1870, pp. 755-756.  |
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